Monitorización del tratamiento antibiótico nebulizado en bronquiectasias no fibrosis quística colonizadas por Pseudomonas aeruginosa. Estudio multicéntrico / Monitoring nebulized antibiotic treatment in non-cystic fibrosis bronchiectasis colonized by Pseudomonas aeruginosa: A multi-centerstudy

OBJETIVOS: 1- Valorar la adherencia al tratamiento nebulizado con colistimetato de sodio-Promixín® con dispositivo Ineb® en pacientes con bronquiectasias (BQ) no fibrosis quística (FQ) colonizadas por Pseudomonas aeruginosa; 2- Identificar un perfil de paciente incumplidor. MÉTODO: Estudio multicéntrico, observacional, prospectivo, de corte transversal, de una cohorte de adultos tratados al menos durante 6 meses con colistimetato de sodio (Promixin®) administrado con el nebulizador Ineb®. Se obtuvieron los registros del tratamiento nebulizado (plataforma informática Insight®), datos de función pulmonar, cultivos de esputo y número de agudizaciones antes y después del tratamiento. Se analizó la adherencia global, el manejo del nebulizador y la adherencia real. Se define a los pacientes con mala adherencia terapéutica como aquellos con una adherencia global o real ≤80%. RESULTADOS: La muestra inicial fue de 126 pacientes, considerándose no válidos para su análisis 20 de ellos, siendo seleccionados 106 pacientes con BQ no FQ, 47 de causa postinfecciosa (44,3%), 13 EPOC (12,3%), 12 discinesia ciliar (11,3%), 17 otras causas(16%) y 17 idiopáticas (16%). La edad media fue de 64,0 ± 14,6 años, 57 varones (53,8%) y 49 mujeres (46,2%), 61 procedentes de hospitales terciarios (57,5%) y 45 de comarcales (42,5%). La adherencia global fue del 86,7 ± 19,3% y en el 73,6% de los casos ≥80%. El 96,6 ± 7,8% de los pacientes manejaron adecuadamente el nebulizador, con unos tiempos de nebulización de 6,3 ± 3,4 minutos. La adherencia real fue del 84,4 ± 20,2% y en el 75,5% de los casos ≥80%. No hubo diferencias en cuanto al sexo, edad, función pulmonar, causa de las BQ no FQ y exacerbaciones previas para ninguna de estas variables. CONCLUSIÓN: En nuestra población el manejo del nebulizador y la adherencia, global y real, es muy buena. El escaso número de pacientes no adherentes no nos ha permitido definir el perfil del incumplidor

OBJECTIVE: 1) Assess adherence to nebulized treatment with colistimethate sodium-Promixin® using an Ineb® nebulizer in patients with bronchiectasis (BQ) but without cystic fibrosis (CF) colonized by Pseudomonas aeruginosa; 2) Identify a noncompliant patient profile. METHOD: A multi-center, observational, prospective, transversal study, with a cohort of adults treated for at least six months with colistimethate sodium (Promixin®) administered with an Ineb® nebulizer. Registers of nebulized treatment were obtained (Insight® IT platform), pulmonary lung function, sputum culture and number of exacerbations prior to and after the treatment. Global adherence was analyzed, as well as handling the nebulizer and real adherence. Patients with poor therapeutic adherence were defined as those with a global or real adherence of ≤80%. RESULTS: The initial sample included 126 patients, 20 of which were considered not valid for the analysis; 106 patients with BQ non-CF, 47 were post-infectious causes(44.3%), 13 COPD (12.3%), 12 ciliary dyskinesia(11.3%), 17 other causes (16%) and 17 idiopathic (16%). The mean age was 64.0 ± 14.6 years; 57 males (53.8%) and 49 females (46.2%), 61 were from tertiary hospitals (57.5%) and 45 from local hospitals (42.5%). Global adherence was 86.7 ± 19.3% and in 73.6% of the cases ≥80%. 96.6 ± 7.8% of the patients adequately handled the nebulizer, with nebulization times of 6.3 ± 3.4 minutes. Real adherence was 84.4 ± 20.2% and in 75.5% of the cases ≥80%. No differences were seen in terms of sex, age, pulmonary function, cause of BQ non-CF and prior exacerbations for none of these variables. CONCLUSION: In our population, handling the nebulizer and adherence, both global and real, is very good. The limited number of patients who failed to adhere has hindered our defining a non-compliant profile

Sleep-related breathing disorders in adolescents aged 12 to 16 years : clinical and polygraphic findings.

STUDY OBJECTIVES: To determine the frequency, symptoms, and polygraphic features of sleep-related breathing disorders (SRBD) in adolescents aged 12 to 16 years. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in the city of Seville, SPAIN: PARTICIPANTS: A general population sample of adolescents (n = 101; mean [+/- SD] age, 13.2 +/- 0.8 years). INTERVENTIONS: An 82-item questionnaire regarding anthropometric data and nocturnal and daytime symptoms suggestive of SRBD was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" in the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent an overnight cardiorespiratory polygraphy at home. RESULTS: Twenty-nine percent of the subjects were snorers. Excessive daytime sleepiness was present in 14% of subjects, and sleep apnea was present in 3%. Polygraphy showed a respiratory disturbance index > or = 10 in 18 subjects (17.8%), but concurrent symptoms highly suggestive of SRBD were found in only 2 subjects (1.9%). Snorers had higher waist-to-hip ratios and a higher frequency of witnessed apnea or labored breathing as well as higher values of respiratory events as compared with nonsnorers. However, oximetry data were similar in both groups. CONCLUSIONS: In a nonselected group of adolescents aged 12 to 16 years, the frequency of symptoms potentially associated with SRBD was similar to that reported for younger children. Snoring was associated with a higher occurrence of other nocturnal symptoms, a more central pattern of body fat distribution, and a higher respiratory disturbance index as compared with nonsnorers. Although polygraphic abnormalities were mild, two cases of probable SRBD were found with a prevalence rate of 1.9%.

[Association of obstructive apnea syndrome during sleep and narcolepsy]. / Asociación del síndrome de apnea obstructiva durante el sueño y la narcolepsia.

Obstructive sleep apnea syndrome (OSAS) is highly prevalent. Daytime hypersomnolence (DHS) is among its symptoms, although other diseases, such as narcolepsy, can also give rise to DHS. We describe three men diagnosed of OSAS whose DHS persisted even after snoring disappeared following treatment with continuous positive airway pressure. We suspected associated narcolepsy, which was confirmed by multiple sleep latency testing. Narcolepsy, therefore, should be considered when DHS persists even after appropriate treatment of OSAS.

[Surgical treatment of adenotonsillar hypertrophy in children with sleep respiratory disorders: changes in polysomnographic patterns]. / Tratamiento quirúrgico de la hipertrofia adenoamigdalar en niños con trastornos respiratorios durante el sueño: cambio en el patrón polisomnográfico.

Adenotonsillar enlargement (ATE) can cause respiratory disorders during sleep in children. The treatment of choice for ATE is adenotonsillectomy and its efficacy must be assessed based on improvement in symptoms and polysomnographic patterns. We studied 11 children (7 boys and 4 girls, age 5.5 years) whose ATE symptoms were corrected by adenotonsillectomy. Two nighttime polysomnograms (SleepLab) were recorded, one at baseline and one 6 months after adenotonsillectomy. Polysomnographic recordings were analyzed by quantifying 1) only apneic or hypopneic events lasting > or = 10 sec and 2) all respiratory events > or = 5 sec. The most common symptoms were snoring, nocturnal dyspnea and sleep apnea. Symptoms resolved after adenotonsillectomy for most patients. Obstructive events, in particular shorter apneic events (> or = 5 sec) and instances of hypopnea, decreased after surgery. We found no changes in baseline SaO2, although the minimum SaO2 improved and the number of desaturations decreased, above all those stemming from respiratory events.

[Respiratory polygraphy in the diagnosis of obstructive sleep apnea syndrome]. / Poligrafía respiratoria en el diagnóstico del síndrome de apneas obstructivas durante el sueño.

The traditional way of diagnosing obstructive sleep apnea syndrome (OSAS) is all-night polysomnographic recording. A proposed alternative is respiratory polygraphy, a simplified procedure that consists in nighttime monitoring of oxygen saturation, oronasal flow and respiratory movements. Our aim was to evaluate the efficacy of respiratory polygraphy in diagnosing OSAS in comparison with conventional polysomnography. We studied 101 patients (92 men and 9 women) who had undergone polysomnography. An apnea-hypopnea index (AHI) > or = 10 was considered to be the diagnostic criterion for OSAS. To assess the diagnostic validity of respiratory polygraphy we considered that an AHI per hour of recording > or = 10 and a desaturation index per hour of recording > or = 10 were consistent with a diagnosis of OSAS. Sixty patients were diagnosed of OSAS. The AHI per hour of recording was > or = 10 in 56 patients, with 4 false negatives (sensitivity 93.3% and specificity 100%). The desaturation index per hour of recording was > or = 10 in 65 patients, with 7 false positives and 2 false negatives (sensitivity 96.6% and specificity 82.9%). We conclude that respiratory polysomnography is a specific, highly sensitive method for diagnosing OSAS.

[The detection of the sleep apnea syndrome in a population of professional drivers]. / Detección del síndrome de apnea obstructiva del sueño en una población de conductores profesionales.

The aim of this study was to reduce the risk of traffic accidents related to obstructive sleep apnea syndrome (OSAS) by means its detection and treatment in a group of 100 commercial drivers from Seville. Besides, to analyze which clinical findings could suggest OSAS. By means a questionnaire we selected subjects without (questionnaire score < 10 points) and with (questionnaire score > or = 10) clinical history of OSAS. In cases with score > or = 10, an overnight home polygraphy was carried out (Apnoescreen II, Jaeger), with measurement of oronasal airflow, chest and abdominal movements, oxygen saturation, electrocardiogram, body position and actimetry. We performed a manual analysis of recordings, and polygraphy was considered to be positive for OSAS if both AHI (respiratory events Index) or DI (desaturation Index) were > or = 10. In these positive cases, overnight conventional polysomnography was carried out (SleepLab, Jaeger), with therapeutic tests with CPAP if OSAS was diagnosed (AHI > or = 10). Average age and BMI (Body Mass Index) were 41.5 +/- 0.9 years and 28.2 +/- 0.4 kg/m2. Questionnaire was positive in 59 subjects, in 35 of whom home polysomnography was done. We did not find differences in age, BMI, neck circumference or symptomatology among these 35 drivers and the 24 remaining subjects in whom home polygraphy was not performed. Home polygraphy was positive in 10 subjects and negative In 25. Drivers in first group were older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness. We did not find differences in neck circumference, waist/hip ratio nor alcohol consumption between both groups. From the group with positive polygraphy, we performed conventional polysomnography in 8 cases and OSAS was diagnosed in 5 (in all cases, treatment with CPAP was started). This study does not provide data about prevalence, but it seems that the percentage of our drivers with OSAS could be lightly higher than the prevalence in general population. These subjects seem to be older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness.

Polysomnographic studies in children with adenotonsillar hypertrophy and suspected obstructive sleep apnea.

Upper airway obstruction causes many sleep-related respiratory disorders that can culminate in obstructive sleep apnea syndrome (OSAS). Polysomnography is routinely used to define OSAS in adults, but problems remain in diagnosing children by this method. The current study was designed to analyze the polysomnographic patterns in children with symptomatic adenotonsillar hypertrophy and to determine whether obstructive respiratory events shorter than 10 sec could have pathophysiological significance. Furthermore, we analyzed the correlation between clinical data on children with adenotonsillar hypertrophy and polysomnographic findings. Twelve children (mean age, 4.5 +/- 1.5 years) with airflow obstruction due to adenotonsillar hypertrophy were observed in our Sleep Laboratory. Prior to study, a questionnaire was used to score symptom severity. Overnight polysomnography was then performed to measure total sleep time, sleep efficiency, desaturation index, minimal arterial oxygen saturation (SaO2), apneahypopnea (AH) episodes < or = 5 sec and those > or = 10 sec, and AH index, AH percentage of total test time, and number of spontaneous and respiratory event-associated desaturations were recorded. Respiratory events of 5 sec or longer resulted in increases in the AH index and an increase in the number of oxyhemoglobin desaturations due to respiratory events. A significant relationship was found between the AH index and AH episodes > or = 5 sec and > or = 10 sec. There was, however, no association between polysomnographic parameters and symptom severity scores. An appraisal of AH recordings > or = 10 sec showed that desaturation episodes were more frequent than respiratory events, and the desaturation index was closely related to spontaneous and respiratory event-associated desaturations. When considering all obstructive episodes > or = 5 sec, the number of desaturations did not exceed the number of respiratory events. The correlation between the desaturation index and spontaneous or respiratory event associated desaturations was similar. The occurrence of short AH episodes that lead to hemoglobin desaturation are important in the evaluation of OSAS in children.

[Hypercapnic stimulation and ventilation response in the syndrome of sleep obstructive apnea. Comparison of reinhalation and steady state]. / Estimulación hipercápnica y respuesta ventilatoria en el síndrome de apnea obstructiva del sueño. Comparación de reinhalación y estado-estable.

The objective of this study was to assess ventilatory response to stimulation with CO2 in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper- and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. We later analyzed ventilatory response by the stable-state method, with increasing CO2 concentrations (from 1 to 9%) and by the rebreathing method. Results from the two methods were similar for all patients: delta VE/delta PCO2 (0.64 +/- 0.35 vs 0.67 +/- 0.48 l/min/mmHg; p = 0.59), delta Vt/delta PCO2 (28.33 +/- 16.23 vs 26.42 +/- 16.94 ml/mmHg; p = 0.9), delta Vt/Ti/delta PCO2 (28.82 +/- 20.9 vs 29.41 +/- 23.78 ml/s/mmHg; p = 0.89) y delta P0.1/delta PCO2 (0.11 +/- 0.07 vs 0.117 +/- 0.05 cmH2O/mmHg; p = 0.58). We compared the results obtained by the two techniques by dividing the sample into two groups of 7 and 8 patients, respectively, depending on whether PaCO2 level before stimulation was higher or lower than 45 mmHg. The hypercapnic patients (group I) were older (61 +/- 3.5 vs 50 +/- 9 years; p = 0.04) but were not different with respect to body mass from the normocapnic patients (group II) (37.59 +/- 6.4 vs 34.56 +/- 4.75 kg/m2; p = 0.33). The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0.03) in patients with daytime hypercapnia in delta VE/delta PCO2 delta Vt/delta PCO2, delta Vt/Ti/delta PCO2 and delta P0.1/delta PCO2. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO2 in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.

[Effects of nasal continuous positive airway pressure on lung function in patients with sleep obstructive apnea syndrome]. / Efectos de la presión positiva continua nasal (CPAPn) sobre la función pulmonar en pacientes con síndrome de apnea obstructiva del sueño (SAOS).

Sixty-one patients with obstructive sleep apnea syndrome (OSAS), 26 of whom also had chronic obstructive pulmonary disease (COPD), received treatment by nasal continuous positive airways pressure (nCPAP). To evaluate the effects of this device on daytime lung function, we analyzed pulmonary function tests before treatment with nCPAP and after a mean follow-up period of 12 months (range: 2-22 months). In patients with both OSAS and COPD, we observed a significant decrease in PaCO2 (p < 0.007), in airways resistance (p < 0.002) and in residual volume (p < 0.01); for these same patients we recorded increases in forced vital capacity (p < 0.04) and maximum inspiratory pressure (p < 0.02). We saw no change in lung function in patients with OSAS only. PaO2 increased after treatment in the 15 patients who were initially hypoxemic (p < 0.001). We conclude that after treatment with nCPAP, the greatest changes in respiratory function occur in patients with both OSAS and COPD, who also experience slight decrease in body weight. These changes may be explained by a decrease in auto-PEEP and weight loss.

[Brief polysomnographic studies in the diagnosis of the obstructive sleep apnea syndrome]. / Estudios polisomnográficos cortos en el diagnóstico del síndrome de apnea obstructiva del sueño.

Firm diagnosis of obstructive sleep apnea syndrome (OSAS) is normally based on all-night-long polysomnograms, at considerable expenditure of time and money. Shorter studies have been proposed as an alternative. We have assessed the efficacy of polysomnograms recorded over the first three hours of nocturnal sleep (SN) for diagnosing OSAS and the results have been compared with those of polysomnograms recorded throughout the entire night (EN). Twenty-five male patients suspected of having OSAS were enrolled; 19 were diagnosed for OSAS by EN and 16 were diagnosed by SN, indicating 3 false negatives and a sensitivity of 84% for SS. No false positives were obtained by studying only the first three hours of sleep, indicating a specificity of 100%. Significant differences were found in minimum oxygen saturation (SatO2) and percent of total sleep time with intervals of SatO2 below 80%. We conclude that polysomnography during the first part of nocturnal sleep is a specific method for screening for OSAS and that, although this method's sensitivity is high, study should be continued throughout an entire night when results are negative. Desaturation levels may be underestimated in recordings lasting only the first half of the night.

[Short-term effects of respiration with external negative ventilation --shield-type respirator-- on the pulmonary function in COPD]. / Efectos a corto plazo de la respiración con ventilación negativa externa--respirador tipo coraza--sobre la función pulmonar en la EPOC.

With the objective to test the effect of intermittent and short term rest in respiratory muscles in patients with COPD and maintained hypercapnia we have studied 34 patients in a stable condition: 23 were part of the study group (Group I) and 11 were the control group (Group II). After a complete functional basal study, patients in Group I were treated with intermittent rest of their respiratory muscles, through a negative pressure external respirator--shield type--during three consecutive days. We got, in this study group, a significative improvement in the maximum inspiratory pressure measured at residual volume (PI max RV), which went from 66.6 +/- 15.9 to 71.2 +/- 15.2 (p < 0.005), as well as a lowering, also significative, of partial pressure of CO2 in arterial blood (PaCO2) and in expired air (EFCO2), which went from 55.2 +/- 7.2 to 52.3 +/- 3 (p < 0.0002) and 3.3 +/- 0.5 to 3.1 +/- 0.5 (p < 0.01), respectively. Maximum inspiratory pressure measured to functional residual capacity (PI max FRC) experienced an increase in the limit of statistical signification. Rest of the parameters did not significantly change. These results back the hypothesis that in stabilized COPD with CO2 retention, a chronic fatigue of respiratory muscles could exist, and that intermittent rest of these muscles could mean an hypercapnia diminution, due to the improvement in the function of respiratory muscles.